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LAND USE PERMIT APPLICATION - Burnett County, WI <br /> CL J <br /> b <br /> Applicant Complete All Sections Below This Line o <br /> fL <br /> '-- <br /> Permit Types and Fees:(Please,check appropriate boxes) o <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 '� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 R� 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 j 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 0 ; <br /> . Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r- <br /> Filling/Grading $150 Boathouse $500 o ; <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 v' <br /> 0 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. P <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> CD I <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r- g <br /> r o <br /> Property Owner's Name: NA1 C 110 e.I -4- -1 tar' AO. I + 1 n <br /> g c rl ci ta-f-e. Pica ad 35 L,t)e.b5-tc✓ VI- 5 4-0-(5 r <br /> PropertyOwner's Mailing Address: -a <br /> ' ' \ City to �„ <br /> Property Site Address: LDhitf' �'atJ W1 IcieY- ness R.0 var LQ-1-`-- )(P <br /> 0 h <br /> _ <br /> Contact's Telephone Number: 1 5 - ;( - ea(7k0 o Contact's Email: C,�) 1t etc&t J l�I iCl d 17eSS ho (1lcu . CO 1kog- <br /> . V 7 <br /> Legal Description of Property: I rl C l t,t CI t'C/ N <br /> 0 w <br /> Section#:_,:2j, Town#: 1 HO N Range#: f(p W Town of: Crt K I a Y) o N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* = —{� <br /> Tax ID#(1-5 digit number; found on tax statement): 1L,9 T7 G 23 3 <br /> Proposed Use of Structure/Addition: E.Q._rn p R co Lt n d S f rL) (`*0 re._ —I G <br /> Anticipated Start Date: Itt)fl1f'(t,t.(t ' Home/Cahin;Commercial Business;Bedroom;Deck;etc.) ^' p <br /> Building Contractor: iv I Sewer Installer: — �> _ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 0 Z. <br /> Qfo//ow a// CePitc440f11s -61','"1 C °,-2-1-149' st VI <br /> 6017i1 %5 `led4 e 7a be. w)a iW by /°//zoz S/ »6 mil N <br /> t e / 5 /N7� co�1/i 4 uce_ LA / S/Ze_ /1 .{-5, W <br /> -� Fee Reel?.S?:IC? <br /> ,� n 3.7) <br /> Check#: �/9 <br /> l o" W\V— C <br /> Date of staff site visit: �' e, Initials of site visit staff: � r <br /> —tZ <br /> ( 1 <br /> APPROVED BY LAND SERVICES OFFICIAL: /.`'"'" - DATE: S�/zeact r �-"�^il <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF " k g a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT • o N <br /> o <br /> / 1::: <br /> Transcendent: - Page 1 of 4 • m <br /> Laserfische: - Burnett County, WI Land Use Application -Rev 1/2020 <br /> J <br /> ro <br />